Govetto Andrea, Lalane Robert A, Sarraf David, Figueroa Marta S, Hubschman Jean Pierre
Retina Division, Stein Eye Institute, University of California Los Angeles, Los Angeles, California.
Retina Division, Stein Eye Institute, University of California Los Angeles, Los Angeles, California.
Am J Ophthalmol. 2017 Mar;175:99-113. doi: 10.1016/j.ajo.2016.12.006. Epub 2016 Dec 18.
To describe the presence of continuous ectopic inner foveal layers associated with epiretinal membranes (ERMs) and to present a new optical coherence tomography (OCT) staging system of ERMs.
Retrospective multicenter observational case series.
Clinical charts and spectral-domain OCT images of 194 eyes of 172 consecutive patients diagnosed with ERMs were reviewed and analyzed.
The presence of continuous ectopic inner foveal layers was identified in 63 out of 194 eyes (32.5%) and this morphology was significantly associated with lower visual acuity. ERMs were divided into 4 stages. Stage 1 (43 out of 194 eyes, 22.1%) ERMs were mild and thin and a foveal depression was present. Stage 2 (88 out of 194 eyes, 45.4%) ERMs were associated with widening of the outer nuclear layer and loss of the foveal depression. Stage 3 (51 out of 194 eyes, 26.3%) ERMs were associated with continuous ectopic inner foveal layers crossing the entire foveal area. In stages 1, 2, and 3 all retinal layers were clearly defined on OCT. Stage 4 ERMs (12 out of 194 eyes, 6.2%) were thick and associated with continuous ectopic inner foveal layers. In addition, retinal layers were disrupted. Visual acuity progressively declined from stage 1 through stage 4 (P < .001).
The presence of continuous ectopic inner foveal layers in ERMs is a newly described OCT finding associated with significant vision loss and is an essential element of a novel OCT-based grading scheme of ERMs that may influence visual prognosis.
描述与视网膜前膜（ERM）相关的连续异位中央凹内层的存在，并提出一种新的ERM光学相干断层扫描（OCT）分期系统。
回顾性多中心观察性病例系列。
对172例连续诊断为ERM的患者的194只眼的临床图表和光谱域OCT图像进行回顾和分析。
194只眼中有63只（32.5%）发现存在连续异位中央凹内层，这种形态与较低的视力显著相关。ERM分为4期。1期（194只眼中的43只，22.1%）ERM轻微且薄，存在中央凹凹陷。2期（194只眼中的88只，45.4%）ERM与外核层增宽和中央凹凹陷消失相关。3期（194只眼中的51只，26.3%）ERM与穿过整个中央凹区域的连续异位中央凹内层相关。在1、2和3期，OCT上所有视网膜层均清晰可辨。4期ERM（194只眼中的12只，6.2%）较厚，与连续异位中央凹内层相关。此外，视网膜层中断。视力从1期到4期逐渐下降（P <.001）。
ERM中连续异位中央凹内层的存在是一种新描述的与显著视力丧失相关的OCT表现，是一种可能影响视觉预后的基于OCT的新型ERM分级方案的重要要素。
